Chronic Pelvic Pain Syndrome & Prostatitis: Difference between revisions

** '''<span style="color:#ff0000">Most common pathogens are from the Enterobacteriaceae family (e.g., E. coli, Serratia, Klebsiella, Proteus, Pseudomonas)</span>''', which originate in the gastrointestinal flora.

==== '''<span style="color:#ff0000">Acute prostatitis</span>''' ====

* '''<span style="color:#ff0000">Therapy is initially with parenteral antibiotics (depending on the severity of the infection) followed by oral antibiotics with wide-spectrum antimicrobial activity</span>'''

** '''The most common drugs suggested for initial therapy are a combination of penicillin (i.e., ampicillin) and an aminoglycoside (i.e., gentamicin), second- or third-generation cephalosporins (i.e. ceftriaxone), or one of the fluoroquinolones.'''

*** This traditional approach has changed recently because of the increasing risk of post–prostate biopsy prostate infection with ESBL microorganisms

*** In acute bacterial prostatitis that result from previous manipulation of the lower urinary tract (including prostate biopsy), the organisms show different patterns of virulence and resistance (e.g., to quinolones and cephalosporins) compared with the organisms associated with spontaneous acute prostatitis

** '''<span style="color:#ff0000">In patients with acute prostatitis with ESBL or suspected ESBL organisms (usually associated with transrectal prostate biopsies), treatment with a carbapenem (ertapenem, imipenem, or meropenem),</span>''' amikacin, or colistin '''for at least 10 to 14 days is recommended'''

* '''<span style="color:#ff0000">Once the acute infection has settled down, therapy should be continued with one of the oral antimicrobial agents</span> appropriate for the treatment of chronic bacterial prostatitis''' (e.g., trimethoprim or fluoroquinolones or ESBL-effective antimicrobial therapy based on sensitivity analysis). '''The duration of optimal therapy is unknown; <span style="color:#ff0000">between 2 and 4 weeks has been suggested</span>'''

 

==== '''<span style="color:#ff0000">CPPS</span>''' ====

* Medical therapies that have been properly evaluated in RCTs in CPPS: antibiotics, α-adrenergic blockers, anti-inflammatory agents, hormonal therapies, phytotherapies, and pregabalin

* Minimally invasive therapies that have been properly evaluated in RCTs in CPPS: extracorporeal shockwave therapy (ESWT), transurethral microwave therapy (TUMT), and neuromodulation (electrostimulation, botulinum toxin).

* '''<span style="color:#ff0000">Therapies that have shown benefits in placebo sham-controlled studies in CPPS:</span>'''

** '''<span style="color:#ff0000">Marked benefit—none</span>'''

** '''<span style="color:#ff0000">Moderate benefit in some selected trials (2):</span>'''

**# '''<span style="color:#ff0000">α-adrenergic blockers</span>'''

**# '''<span style="color:#ff0000">Pregabalin</span>'''

** '''<span style="color:#ff0000">Modest benefit</span>'''

**# '''<span style="color:#ff0000">Anti-inflammatory agents</span>'''

**# '''<span style="color:#ff0000">Phytotherapies</span>'''

**# '''<span style="color:#ff0000">ESWT</span>'''

**# '''<span style="color:#ff0000">TUMT</span>'''

**# '''<span style="color:#ff0000">Selected neurostimulation</span>'''

* '''<span style="color:#ff0000">Recommended</span>'''

*# '''<span style="color:#ff0000">α-Blocker therapy as part of a multimodal treatment strategy for newly diagnosed, α blocker–naive patients who have voiding symptoms.</span>'''

*# '''<span style="color:#ff0000">Antibiotic trial for selected newly diagnosed, antibiotic-naive patients</span>'''

*# '''<span style="color:#ff0000">Selected phytotherapies: Cernilton and Quercetin</span>'''

*# '''<span style="color:#ff0000">Multimodal therapy directed at individual UPOINT phenotypes may result in better management outcomes</span>'''

*# '''<span style="color:#ff0000">Directed physiotherapy</span>'''

* '''<span style="color:#ff0000">Not recommended</span>'''

*# '''<span style="color:#ff0000">α-Blocker monotherapy,</span> particularly in patients previously treated with α-blockers.'''

*# '''<span style="color:#ff0000">Anti-inflammatory monotherapy</span>'''

*# '''Antibiotics as primary therapy, particularly for patients in whom treatment with antibiotics has previously failed'''

*# '''5α-Reductase inhibitor monotherapy;''' can be considered in older patients with coexisting benign prostatic hyperplasia

*# '''Most minimally invasive therapies''' such as transurethral needle ablation (TUNA), laser therapies

*# '''Invasive surgical therapies''' such as transurethral resection of the prostate (TURP) and radical prostatectomy

* Requiring further evaluation

*# Low-intensity shock wave treatment.

*# Acupuncture.

*# Biofeedback.

*# Invasive neuromodulation (e.g., pudendal nerve modulation).

*# Electromagnetic stimulation.

*# Botulinum toxin A injection.

*# Medical therapies including mepartricin, muscle relaxants, neuromodulators, immunomodulators.